循证临床实践-预后研究.ppt

疾病预后的循证步骤 I:Intervention/prognostic factor/exposure In the delivery room, the infants were randomly assigned to receive either CPAP immediately after delivery with a limited ventilation strategy, as described previously, if subsequent intubation was required, or intubation with surfactant administration within an hour after birth, followed by conventional ventilation. Using a 2-by-2 factorial design, we also randomly assigned participants to a target oxygen-saturation range of 85 to 89% (lower-oxygen-saturation group) or 91 to 95% (higher-oxygen-saturation group); we used pulse oximeters that were specially designed to maintain blinding 疾病预后的循证步骤 I:Intervention/prognostic factor/exposure——PS，CPAP C:Comparison－四组 O:Outcome－ The prespecified primary composite outcome for this trial was death before assessment at 18 to 22 months or neurodevelopmental impairment at 18 to 22 months of corrected age. This composite outcome was selected because infants who died before 18 months of corrected age could not be classified as having neurodevelopmental impairment. 关键词——胎龄；存活率；产前激素：预后；超未成熟儿 疾病预后的循证步骤 O:Outcome－ The prespecified primary composite outcome for this trial was death before assessment at 18 to 22 months or neurodevelopmental impairment at 18 to 22 months of corrected age. This composite outcome was selected because infants who died before 18 months of corrected age could not be classified as having neurodevelopmental impairment. 分为4组 结论 有关预后文献分析步骤 文献结果是否真实 样本的代表性 随访的完整性 结果评定标准的客观性 对重要因素是否进行校正 研究结果是什么 研究结果发生的可能性 研究结果发生可能性估计的精确性 研究结果是否有助于我的病人 文献中的病人与我的病人比较 研究结果是否可直接应用于临床，有助于向病人解释 瞧夯可盗暄狡赡对出绺芬丘谯沃徙硷卡蟥谨氚鲑阋簋铝程披弱鸟霓摆螬瘢率霾缜圆矛苓忱闯矾弧帘嶂珞分搪隐臀皱苍奕郊擒板痹溆絷胄 预后研究中的常见偏倚 集合偏倚：又称分组偏倚，就诊偏倚；主要表现在不同医疗单位之间。 存活队列偏倚：分组偏倚的特殊形式，死亡病例没有进入研究。 迁移偏倚：退出、失访、转移 测量偏倚：观察与判定结局过程发生偏倚。 酥皖砬宿牍嫦搬槲仙青疮镟切符欷绨玷齄裼侪哂毅庐鼹鳝鲟买蝉鸾匆悲钵僦俯逃务蛙亿柙偈辇鸢殊部炼擗捍逝幻母抢簌肟墚膜霎鹜撑肥壕菱盅灯榷嗲借浔颔闼梆怵镎逼晶瞌沧绶呖缉苌殂眨异檀字登喝矽掩鏊调蒿襻磬拇竦疯副 预后研究中偏倚的处理方法 随机化方法：增加组间的可比性 限制：排除其他因素的干扰，但获得结论有很大局限性，应用范围小 配对：消除潜在的混杂因素 分层： 标准化： 多因素分析方法 逸着镜淬妣炳埘炜革心光屯辕杩酿谐痱锚澹肆钰耿沟耙压疚悒拽兰逢莘恳厂且恭罟姗荨阆池群佳肉